Provider Demographics
NPI:1427357078
Name:LATELL, PAUL R (MSW, LISW-S)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:R
Last Name:LATELL
Suffix:
Gender:M
Credentials:MSW, LISW-S
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:R
Other - Last Name:LATELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LISW
Mailing Address - Street 1:8577 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-2345
Mailing Address - Country:US
Mailing Address - Phone:330-856-6663
Mailing Address - Fax:
Practice Address - Street 1:8577 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2345
Practice Address - Country:US
Practice Address - Phone:330-856-6663
Practice Address - Fax:330-856-1581
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1000314-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical